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Characterization of risk factors and mortality in young patients with acute myocardial infarction
Session:
Posters (Sessão 5 - Écran 1) - DAC e Cuidados Intensivos 6 - MINOCA, género e idade
Speaker:
João Borges Rosa
Congress:
CPC 2022
Topic:
E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Theme:
13. Acute Coronary Syndromes
Subtheme:
13.2 Acute Coronary Syndromes – Epidemiology, Prognosis, Outcome
Session Type:
Pósters Electrónicos
FP Number:
---
Authors:
João Borges Rosa; Sofia s. Martinho; José Lopes de Almeida; Gustavo m. Campos; João André Ferreira; s. Monteiro; f. Gonçalves; p. Monteiro; r. Baptista; Manuel Oliveira-Santos; Lino Gonçalves
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Introduction: The incidence of acute myocardial infarction (AMI) among young patients is increasing. Recently, in two cohorts of type 1 AMI from the United States of America, the YOUNG-MI Registry reported that patients under 40 years had similar risk profiles and outcomes compared to those aged 41 to 50 at the time of the event. We aimed to evaluate cardiovascular risk factors and mortality outcomes in two age cohorts from a southern European population. </span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Methods: We retrospectively evaluated 4758 patients admitted to our coronary intensive care unit between 2004 and 2017 with a diagnosis of non-ST-elevation myocardial infarction (NSTEMI) or ST-elevation myocardial infarction (STEMI). We only included patients <60 years old in two subgroups: cohort A (< 50 years) and cohort B (50-60 years). Clinical and all-cause mortality data were collected. T-tests and Pearson’s chi-squared tests were used for group comparison, while survival analysis was performed using Kaplan-Meier curves and multivariable Cox regression.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Results: We selected 1233 patients with mean age 50.5 ± 6.5 years, 82.2% male, and 53% diagnosed with STEMI. Cohort B had higher rates of hypertension (59.8 vs. 42.9%, p<0.001), diabetes (41.8 vs. 28.9%, p<0.001), and dyslipidemia (59.4 vs. 46.4%, p<0.001). However, cohort A had higher rates of familial premature coronary artery disease (20.9 vs. 13.2%, p<0.001) and smoking habits (54.4 vs. 40.0%, p<0.001). Cohort A had lower all-cause mortality rates at the index hospitalization (1.3 vs. 3.2%, p=0.045), 6-months (2.9 vs.5.4, p=0.038), 1-year (3.1 vs. 6.3%, p=0.014), and 3-years (3.6 vs 8.4, p=0.001). After multivariable adjustment, we found no relationship between age cohorts and all-cause mortality for any follow-up timing: HR 1.57 (95% CI 0.56-4.37), 1.37 (95% CI 0.50-3.74), and 0.92 (95% CI 0.35-2.39) at 6-months, 1-year, and 3-years, respectively. Regarding coronary angiography (Figure 1), cohort B had higher rates of obstructive disease in each epicardial artery, except for left main involvement (3.6 vs. 1.8%, p=0.072). Also, the rate of non-obstructive disease was similar between groups (9.2 vs. 11.6%, p=0.165). </span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Conclusion: Among patients who suffer AMI, those under 50 years old have a clearly different risk profile, compared to those patients between 50 and 60 years. Despite lower rates of death in younger patients, after multivariable adjustments there is no significant difference in all-cause mortality.</span></span></p>
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